Here is a good video about testosterone and BAT since there is a lot of interest on the forum based recent posts and replies.
Testosterone Therapy in Men with Advanced Prostate Cancer – Summary:
Abraham Morgentaler, MD, explains new concepts that could subvert the long-held belief that high levels of testosterone exacerbate prostate cancer growth. He discusses the androgen saturation model, as well as the benefits of testosterone therapy for patients’ quality of life.
Thanks for putting this out there. Most of us have been solemnly told by an oncologist that T is fuel for cancer. This has been the basic rationale for most treatments since Huggins. That is about 80 years. And there was no evidence! Morgenthaler talks of going to the Huggins library in NY. One of our number (take a bow Nalakrats) recently went there too and read the papers and notes and confirmed that Huggins did a high T trial on men in their final stages. The initial sample was 3. Two were excluded from the results for various reasons. So a n=1 sample is the basis for the belief that T is fuel for cancer. And that one was heavily biassed. He was about to die anyway.
Anyway, everyone here needs to have a look at this. It greatly surprised me recently to learn that knowledgeable people still believe the T is fuel story. Here in Australia it is still believed by most medical practitioners and it is still taught in medical schools.
So it has been proven that low T via ADT or castration has no efficacy as far as increasing life expectancy for PCa guys? Thus, it has been shown that ADT, etc does not increase average life expectancy for PCa guys? So, it is a treatment without any basis in fact??? And a treatment advised by leading academic practitioners? Really?
One needs to read kaptank's comment in the context of what's being discussed: TRT, or the use of exogenous T.
Yes, removing endogenous T serves as effective therapy for slowing cancer (temporarily) nearly always. But if that fact reflected a simple truth of "more T = more cancer" then ADDED testosterone would serve to accelerate PC progression nearly always, in a dose-dependent manner. That is not the case.
We also know that it is only "near-zero T = less cancer" and NOT simply lesser amounts that provide benefit, as in "low-T = less cancer." The fact that lower levels of naturally occurring T have been associated with MORE cancer tells us that PC occurrence and progression are not a reflection of a direct relationship with increasing T levels.
To use an analogy, slowly pushing down on a car's gas pedal always increases the flow of gas to the car's engine and increases speed proportionally, by design. Men are "designed" such that adding more T does NOT always increase the speed and aggressiveness of PC progression.
While it may be intuitive to suppose that since removing all T slows PC progression then adding extra T must always accelerate PC progression, scientific experimentation and observation do not confirm that intuition.
No, that is not right. Castrate T is till the first line of defense and it is effective - until it is not and the PCa adapts to it. What Morgenthaler has shown is that the assumption is false that increasing T to very high levels swill cause the cancer to proliferate, like pouring petrol on a fire. More petrol, more fire, without limit. That just does not happen. The metaphor is more like watering a plant. The water is the T, the plant growth is the PCa, Starve the plant of water and it will die. Increase the water and it will thrive. But over water it and it will die then as well.
So, in some situations, removing the fuel does help, I think the use of fuel here is misplaced, since for some men in certain situations both removing T and adding T can be beneficial apparently. Unfortunately, for which men BAT might help is still unknown correct? So, not SOC with the necessary supporting studies?
Yes, thinking in terms of fuel does not help. It is a simple metaphor and it doesn't work.
I think in most cases removing T works for a while, with all the side effects. But in most cases, ADT is for life. That is big time SOC. On the other hand, greatly increasing T suddenly to levels way above normal may be beneficial but we do not know exactly the best way to approach this. (Supra T can be done while on ADT. ) We don't know how an individual can be expected to react, but for BAT at least it seems pretty safe, no sudden explosions of cancer. (proviso: not an end of life therapy, high bone pain etc) BAT minimises exposure to supra T - it is a transient spike. The other ways to approach this is to have long periods of continuous supra T interspersed with periods of, say enzalutamide. Or just full blown supra T continuously with careful monitoring. We know less about these but some of our number are experimenting - there is a bit of past evidence and some docs figure its worth trying in some cases. It is not totally out there and has some basis and certainly improves quality of life. We all have to make our own risk analysis and decision taking in mind of quality of life.
So: definitely not SOC.
If testosterone would have no influence on prostate cancer ADT would not be effective.
However, the advocates for BAT refer to this article by Huggins:
cancerres.aacrjournals.org/...
It mentions: "There are 2 principles in the destruction of cancer cells in living creatures by modifications of endocrine status:
(a) hormone deprival;
(b) hormone interference in the cancer cell. Malignant cells can regress from too little or too much hormone."
With other words, too much testosterone can damage prostate cancer cells. This seems to be the case particularly with resistant cells which mutated to have many more androgen (testosterone) receptors to grow at low testosterone levels and cannot handle a sudden flood of testosterone.
I would add that "(b) hormone interference in the cancer cell" could, in theory, refer not just to the potential benefit of flooding cancer cells with testosterone. A cancer cell might be damaged by being flooded with a different hormone, too, such as estrogen. (This direct cytotoxic effect would be in addition to the T-reduction that comes as a result of estrogen therapy.)
Thank you mtnwife! -Patrick
This talk, Abraham Morgentaler, MD, in addition with Dr Myers for combinational therapies and Dr Tanya Dorff for demystifying chemo therapy - created my PCa personal treatment agenda for my first visit (2 years ago) with my Dana-Farber oncologist. Diagnosed PSA 1000+ with extensive tumors all over pelvic area, with a specific large tumor extending from my prostate, invading the bladder wall - causing extreme painful urination with blood.
Typical PCa treatment of ADT for life is obsolete, if you got this plan, move on to an active Oncologist...
ADT is not obsolete. But it is only temporarily effective and the side effects are bad. What is false is the idea that very high T is bad.
"ADT is not obsolete", I know, it stopped my excruciating pain while urinating and dropped my PSA from 1000+ to <0.02.
"Typical PCa treatment of ADT for life is obsolete", It's the ADT kick the can (treatment) down the road that's obsolete. And wait for eventual castration resistance, Dr Myers says keep the cancer on ropes, keep attacking it with various treatments.
You are quite right there. SOC is so that Oncologists can go on to the next patient. Give him ADT and send him home to die slowly
You got my message, just giving ADT is a lazy Oncologist's habit. Cancer evolves, so...
I could not agree more with the above. I think as docs slowly come to realise that the T/PCa relation ship is much more complex than previously assumed they will become more amenable to trying other things that they previously just would not contemplate. Remember that until Huggins in the 1940s there was NO treatment for PCa. Nil, nada, nyet. Go home and die was the only advice. ADT has at least given millions of men a few more years. Huggins deserved his Nobel for that.
I’m on that train😳
Next!😷
Yes, but unfortunately once you get on the ADT merry go round you are usually on it for life (with some exceptions) because what you do not want to happen is to get to a low-normal T level of about hypgonadism. That is where the PCa is happiest.
I was on TRT for ten years to treat hypogonadism. First I got shots then switched to topical gel after shots caused acne. When dxed with Pca in 2013 I stopped TRT had RP ( gl9 Pt3b post RP), and have had oligometastatic Pca since treated with IMRT and IADT then switched to full time estradiol patches to get rid of the ADT side effects. I work out strenuously , play a little golf and lost weight but I’ve lost strength and have fatigue. Does it make sense for me to talk to Morgentaler? I did years back and he didn’t think I was a Candidate for his tx. Have things changed? Bob
I don't know with with respect to Morgenthaler. I am in Australia. One point I would note is that TRT is not BAT. For Bat you must get to supraphysiological levels - much more that the maximum physiological level. Only by injection with T cypionate is that possible. Gels and patches cannot do it. You may well know this but it is worth emphasising as there is a very prominent member here who does not understand the difference and cites TRT as a part of BAT. Every thing we see so far indicates that TRT is very risky with PCA. There are old trials indicating exactly this that our member cites as evidence against BAT.
Bipolar Androgen Therapy [BAT] & CRPC - Sam Denmeade, Hopkins.Bipolar androgen therapy in men with metastatic castration-resistant prostate cancer after progression on enzalutamide.Low T could hasten time to post-RP biochemical recurrence.Testosterone Therapy & PCa Risk.
Good News Story from Australia: Apalutamide to become available on PBS for men living with mHSPC
